The heart’s four valves function like one-way doors, ensuring blood flows efficiently through the chambers and out to the body. When a valve fails to open or close properly, it disrupts the circulatory system. This failure is typically stenosis (narrowing that restricts blood flow) or regurgitation (leaking that causes blood to flow backward). While complex surgical operations were once the only solution for a severely diseased valve, advancements in medical technology have changed this reality. A heart valve can now be replaced without open heart surgery using specialized, minimally invasive, catheter-based techniques.
The Traditional Standard: Surgical Valve Replacement
The conventional method for replacing a diseased heart valve is Surgical Aortic Valve Replacement (SAVR). This established procedure requires a significant intervention, starting with a sternotomy—a large incision down the center of the chest that divides the breastbone to access the heart.
Once the heart is exposed, the patient is placed on a cardiopulmonary bypass machine (heart-lung machine). This device temporarily takes over the function of the heart and lungs, allowing the heart to be stopped for the replacement. The surgeon removes the faulty native valve and sutures a new prosthetic valve into its place. This extensive procedure involves a longer time under anesthesia and a recovery process dictated by the trauma of the chest incision and bypass use.
Transcatheter Valve Replacement Procedures
Catheter-based technology has introduced a less invasive alternative that avoids a large chest incision. These methods, known as transcatheter procedures, deliver a new valve through the body’s existing blood vessels. The most common procedure is Transcatheter Aortic Valve Replacement (TAVR), designed to treat severe aortic stenosis.
TAVR involves implanting a collapsible replacement valve directly into the diseased aortic valve site. The surgeon does not remove the old, calcified valve. Instead, the new valve is positioned and deployed within the native valve’s leaflets, pushing them aside to create a new, functional passageway for blood flow. Similar transcatheter techniques are now available for other valves, including the mitral and tricuspid valves.
Performing the Procedure: Mechanics and Delivery
Access and Guidance
The transcatheter procedure relies on accessing the circulatory system through a small puncture. The most common entry point is the transfemoral approach, where a thin, flexible catheter is inserted into the femoral artery in the groin. This allows the medical team to thread the delivery system, containing the collapsed replacement valve, up through the arteries to the heart. The delivery catheter is carefully guided under continuous X-ray imaging until it reaches the site of the faulty valve.
Valve Deployment
The new valve, typically constructed from animal tissue and mounted on a wire frame, is positioned within the old valve. Some prosthetic valves are designed to be expanded by a balloon, while others are self-expanding and open upon release from the catheter sheath. Once deployed, the new valve is anchored in place by the outward force of its frame, immediately regulating blood flow.
Alternative Access
If the femoral route is not suitable due to narrow or diseased arteries, alternative access sites may be used. These include the subclavian artery in the shoulder or a small incision near the tip of the heart, known as the transapical approach.
Patient Eligibility and Post-Procedure Recovery
Patient Eligibility
Determining eligibility for a transcatheter procedure involves a comprehensive risk stratification and anatomical assessment by a specialized heart team. Initially reserved for patients considered high-risk for traditional open heart surgery, TAVR is now approved for individuals across all surgical risk levels for severe aortic stenosis. Anatomical factors remain significant, as the size and structure of the patient’s arteries and heart chambers must be suitable for the catheter and the new valve device.
Post-Procedure Recovery
The primary benefit of the transcatheter approach is the improved post-procedure recovery. Since the breastbone is not cut and the heart is not stopped, patients experience substantially reduced pain and trauma compared to SAVR. This translates to significantly shorter hospital stays, with many patients discharged the day after the procedure. They often return to normal daily activities and full physical function much faster than the typical six to eight weeks required for recovery from open heart surgery.